Job title:

Utilization Management LVN

Responsibilities:

• Review and authorize referral requests, coordinating with the Medical Director as needed.
• Coordinate with contracting to obtain appropriate contracts.
• Identify cases needing additional case management.
• Compose denial letters in compliance with regulations and standards.
• Ensure denial notices are clear and specific to the member's condition.
• Provide relevant clinical information for decision-making.
• Document communications with providers regarding criteria applied.

Must haves:

-2-3 years of recent experience working in a Utilization Management LVN position

-CA LVN license

-Needs to be VERY strong with prior authorizations (no inpatient) since bulk of work will be focused on this

-Experience with Medicare, MediCAL, commercial guidelines, etc

-Prefers someone who has worked in a remote setting/tech savvy and can hit the ground running

-Experience with DMEs, hospital procedures, reviews and denials

-MUST CURRENTLY RESIDE IN SOUTHERN CALIFORNIA TO BE CONSIDERED